DIPHTHERIA. • 293

point in exactly the same way as the cases of true diph-
theria.

3. c' Cases of diphtheria present the ordinary clinical feat-
ures of diphtheria, and show the Klebs-Loffler bacilli.

4. " Cases of angina associated with the production
of membrane in which no diphtheria bacilli are found
might be regarded from a clinical standpoint as diph-
theria, but bacteriological examination shows that some
other organism than the Klebs-Loffler bacillus is the
cause of the process."

No more convincing proof of the existence of a power-
ful poison in diphtheria could be desired than the evi-
dences of general toxemia resulting from the absorption
of material from a comparatively small number of bacilli
situated upon a little patch of mucous membrane.

In animals artificially inoculated the lesions produced
are not identical with those seen in the human subject,
yet they have the same general features of local infection
with general toxemia.

Guinea-pigs, kittens, and young pups are susceptible
animals. When half a cubic centimeter of a twenty-four-
hour-old bouillon culture is injected beneath the skin of
such an animal, the bacilli multiply at the point of in-
oculation, with the production of a patch of inflamma-
tion associated with a distinct fibrinous exudation and
the presence of an extensive edema. The animal dies in
twenty-four to thirty-six hours. The liver is enlarged,
and sometimes shows minute whitish points, which in
microscopic sections prove to be necrotic areas in which
the cells are completely degenerated and the chromatin of
their nuclei is scattered about in granular form. Similar
necrotic foci, to which attention was first called by Oertel,
are present in nearly all the organs in cases of death from
the toxin. The bacilli are constantly absent from these
lesions. Welch and Flexnerl have shown these foci to
be common to numerous irritant poisonings, and not
peculiar to diphtheria.

1 Bull of the. Johns Hopkins Hospital, Aug., 1891.